Mounjaro may be better than fast-acting Insulin for Type 2 diabetes that is not controlled

Physicians may have a new option for patients with type 2 diabetes that is difficult to control.

Tirzepatide is prescribed for the treatment of diabetes as a first-line drug. It’s also known by its brand name Mounjaro.

A new clinical trial suggests that the medication may also be used as an adjunct therapy by individuals who are prescribed both fast-acting and slow-acting Insulin during mealtimes.

The results of the trial show that adding tripeptide to a slow-acting regimen of Insulin was more effective in lowering the A1CTrusted source and aiding in weight loss. It also had fewer incidences of hypoglycemia among people with uncontrolled type 2 diabetes.

The researchers published these conclusions in the medical journal JAMATrusted source on October 3, based on the findings of the SURPASS-6 randomized clinical trial. Eli Lilly sponsored the clinical trial, which Mounjaro developed.

The authors reported that “Tirzepatide added to basal Insulin at individual or pooled doses led to statistically and clinically meaningful reductions in HbA1C…This glycemic effectiveness was associated with a weight loss and a reduced rate of clinically important hypoglycemia.”

The American Diabetes Association praised the results of the study:

The ADA Standards of Care recommend personalized weight loss goals for those with diabetes or obesity. Tirzepatide has been shown in previous research to be an effective medication for reducing body weight clinically meaningfully,” said Dr. Robert Gabbay Ch, Science and Medical Officer at the American Diabetes Association.

The results of SURPASS-6 support the use of Tirzepatide as a treatment for individuals with type 2 diabetes, obesity, and insulin resistance.

Can Mounjaro be used as an alternative to Insulin?

The primary objective of the study was to determine whether tripeptide is as safe and as effective as Insulin fast-acting in lowering A1C after 52 weeks. The trial observed a secondary outcome of weight loss or prevention.

Open-label trials included 1428 participants between October 2020 and Nov 2022. Open-label means that both participants and doctors are aware of the drug administered. Patients must be 18 years or older and have A1C levels between 7.5% and 11%.

A1C, or hemoglobin HbA1c, is a shorthand term for hemoglobin, the amount of hemoglobin that is bound with glucose (glucose). This is measured over the last three months.

The higher the percentage, the higher the levels of blood glucose.

The National Institute of Diabetes and Digestive and Kidney DiseasesTrusted Source defines the A1C level as:

All participants were given a slow-acting baseline insulin ( Insulin glargine). Those who were “randomized” received either an additional dose of fast-acting (Insulin) insulin or one of the three different dosages of tripeptide (5mg, 10mg, or 15mg). Participants were then observed for 52 weeks after being randomized into other intervention groups.

Researchers observed the differences between the various tripeptide dosages and the fast-acting Insulin, both individually and in a combined cohort.

The pooled group, which included all participants who received tripeptide, had a change in the mean of -2.1% as compared to -1.1% for those taking fast-acting Insulin — nearly double. The A1C percentage reduction was dose-dependent.

The A1C of those who took 10mg or 15mg was -2.2% lower than that of the 5mg group.

Researchers also wanted to know how many participants would reach the A1C limit of 6.5%. This threshold indicates a change in blood sugar levels that are prediabetic.

Only 22% of the group treated with fast-acting Insulin reached this threshold.

A further threshold of 5.7% was explored, which would place participants within a healthy A1C. 18% of the group taking tripeptide reached this threshold, while only 3% of the group using fast-acting Insulin reached the healthy range.

Dr. Marina Basina is a Clinical Professor at Stanford Medicine in the Departments of Medicine – Endocrinology and Gerontology. She said that the study demonstrated how the drug could be used as an alternative to short-acting Insulin when it fails to control blood sugar levels. Basina did not take part in the study.

“Fasting sugar levels were also significantly lower in Moujaro groups when compared to mealtime insulin.” Basina noted that the basal insulin dosage was 30% lower at the start of treatment compared to the usual 10-20% reduction.

This fact encourages us to be more aggressive in reducing insulin dosage when we first start the medication.

Does Mounjaro affect weight loss?

The trial also showed significant weight loss, but that wasn’t a big surprise.

Tirzepatide is a member of a drug class known as glucagon-like peptide-1 receptor antagonistsTrustedSource or GLP-1s, also called GLP-1s. This class includes Ozempic as well as Wegovy, two popular drugs used to treat obesity.

Both GLP-1s share similar interactions with the body.

In a previous study, Mounjaro had a greater effect on weight loss than Ozempic.

Participants in the combined group of tripeptide lost approximately 20 pounds after 52 weeks. Those taking fast-acting Insulin gained five pounds.

Weight loss is also dose-dependent. Participants taking higher doses (e.g., 15mg) lost more weight than those taking the lower dose (5mg).

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